What is the recommended management approach for stable COVID-19 patients in an assisted-living facility?

Management of Stable COVID-19 Patients in Assisted Living Facilities

For stable COVID-19 patients in assisted living facilities, isolation within the facility with supportive care, regular monitoring, and psychosocial support is the recommended management approach, rather than hospital transfer, to reduce mortality and maintain quality of life while preventing disease spread.

Isolation and Infection Control Measures

• Isolate COVID-19 positive residents within the facility in designated areas or their rooms to prevent transmission 1
• Implement strict infection control measures including:
  • Staff use of appropriate personal protective equipment (PPE)
  • Regular hand hygiene
  • Environmental cleaning and disinfection
  • Cohorting of positive cases when possible 1
• Monitor other residents for symptoms and test as appropriate to identify new cases early

Clinical Monitoring and Supportive Care

• Perform regular monitoring of vital signs including:

  • Temperature
  • Respiratory rate
  • Oxygen saturation (SpO2)
  • Heart rate 2

• Provide supportive care including:

  • Adequate hydration
  • Proper nutrition
  • Symptomatic treatment for fever with paracetamol (preferred over NSAIDs) 1
  • Oxygen therapy if SpO2 falls below 94% 2

• Watch for signs of deterioration requiring escalation of care:

  • Rapid day-to-day deterioration
  • Respiratory rate ≥30 breaths/minute
  • SpO2 ≤93% on room air
  • Increasing fatigue or confusion 1, 2

Medication Management

• For cough management:

  • Encourage patients to avoid lying on their back
  • Consider honey for patients over 1 year of age
  • For distressing cough, consider short-term use of codeine linctus or morphine sulfate oral solution 1

• Do not routinely administer corticosteroids for mild to moderate COVID-19 unless indicated for another condition 1

• For high-risk patients with mild-to-moderate symptoms within 7 days of symptom onset, consider remdesivir for 3 days to prevent disease progression 2, 3

Psychosocial Support

• Address potential psychological impacts of isolation:

  • Anxiety
  • Depression
  • Loneliness 1

• Implement strategies to reduce social isolation:

  • Encourage family to drop off letters, drawings, or care packages
  • Facilitate video calls with family members
  • Provide activities such as music, audiobooks, or exercises that can be done in isolation 1

• Use reassuring language and avoid negative terminology (like "crisis," "pandemic," or "isolation") when communicating with residents 1

Staff Considerations

• Ensure staff are trained in:

  • Proper use of PPE
  • Recognition of COVID-19 symptoms
  • Identification of deterioration requiring escalation 1

• Collaborate with mental health professionals and social workers to support residents' psychological needs 1

• Implement regular staff testing protocols to prevent introduction of infection

Special Considerations for Dementia Patients

• For residents with dementia:

  • Maintain regular routines as much as possible
  • Use simple, clear explanations about the situation
  • Provide frequent reassurance
  • Use familiar objects, photographs, or music for comfort 1

• For wandering behavior in COVID-positive residents with dementia:

  • Collaborate with mental health and dementia teams
  • Consider designated safe wandering areas within isolation zones
  • Avoid physical or chemical restraints when possible 1

End-of-Life Considerations

• If a resident's condition deteriorates despite supportive care:

  • Initiate advance care planning discussions if not already completed
  • Consider palliative care consultation
  • Allow family visits for end-of-life situations with appropriate PPE 1

• Signs of terminal phase in COVID-19 patients include:

  • Rapid deterioration
  • Decreased consciousness
  • Inability to swallow
  • Profound weakness
  • Changed breathing pattern
  • Mottled skin 1

By implementing these evidence-based strategies, assisted living facilities can effectively manage stable COVID-19 patients while minimizing mortality risk, maintaining quality of life, and preventing further disease spread within the facility.